Chronic Active TCMR: clinical implications
|
|
- Irma McLaughlin
- 6 years ago
- Views:
Transcription
1 Chronic Active TCMR: i, iatr, i-ifta, and the clinical implications Roslyn B. Mannon, M.D. Professor of Medicine, Division of Nephrology Professor of Surgery, Division of Transplantation Director of Research, Comprehensive Transplant Institute Ruiz, 2002
2 Roslyn B. Mannon, MD University of Alabama at Birmingham I have no financial relationships to disclose within the past 12 months relevant to my presentation and My presentation does include discussion of offlabel or investigational use therapies
3 The Etiology of Chronic Graft Injury ( CGI ): The Bench and Bedside Knowledge IF/TA interstitial fibrosis and tubular atrophy May also be associated with glomerular or arterial lesions Association with TGFb and other growth factors Association with CNI toxicity (chronic) Association with antibody mediated injury (allo, auto) Inflammation in unscared kidney i + IFTA Chronic inflammation in areas of atrophy iatr Final common pathway for many injuries
4 Causes of Graft Loss Over Time T cell Mediated Rejection 60/312 for cause biopsies developed allograft failure Am J Transplant 12: , 2012
5 Cellular Rejection : Evolution of Criteria Dark Ages Banff 91 (Kidney Int 1993; 44:411) Banff 97 (Kidney Int 1999; 55:713) Banff 97 AMR Update (AJT 2003; 3:706) Banff 2005 (AJT 2007; 7: 518) Banff 2007 (AJT 2008; 8:753) Banff 2009, 2011, 2013, 2015 Acute TCM Rejection Grade I: i2 i3 and/ or t2 Type IA: i2,i3, &t2 Type IB: t3 ditto Type IA i2 or i3 +t2 Type IB i2 or i3 +t3 ditto ditto Grade II: t3 and/or intimal arteritis: v1, v2 Type IIA: mild-mod arteritis v1 Type IIB: severe intimal v2 ditto Type IA: v1 Type IIB severe intimal arteritis comprising >25% of luminal area v2 ditto ditto Grade III: transmural arteritis v3 Type II: transmural arteritis V3 ditto Type III; transmural arteritis and/or arterial fibrinoid change and necrosis of medial smooth muscle cells accompanying lymphocytic inflammation v3 ditto ditto Chronic rejection Chronic TCM Rejection Chronic allograft arteriopathy: arterial intimal fibrosis with mononuclear cell infiltration; formation of neointima (ie. cv) ditto ditto
6 Grading Chronic TCMR Banff 2005 Chronic TCMR was defined by sclerosing transplant arteriopathy. This lesion is characterized by intimal widening due to the de novo accumulation of collagens I and III, lack of elastosis, and varying degrees of intimal inflammation with mononuclear inflammatory cells Arterial intimal thickening (cv) % narrowing lumen of most severely affected vessel Grade None I II III 0% <25% 26 50% >50% Am Jnl Transplant 2007; 7: 518
7 Donor Age and cv Score in Healthy Living Donors The findings on core biopsy indicate that significant arteriosclerosis is often present in kidneys from normotensive donors with normal renal function, particularly those older than 40 years. ~Haas et al. Arch Pathol Lab Med 2008; 132:37
8 Cluster Analysis of Lesions in Nonselected Kidney Transplant Biopsies: cv as a correlate of parenchymal scarring 234 for cause biopsies PCA PCA plus ptcml, C4d, Class I or II PRA, TPTx cv lesion may be produced by various stresses, and acts as a nonspecific feature of time-dependent scarring rather than a feature of antibodymediated injury Sis et al. Am Jnl Transplant 2010;10(2): 421
9 cv Lesions and Donor Specific Antibody Progression of cv is associated with transplantation and accelerated in presence of DSA [Hill et al. JAMA 2011; 22(5): 975]. 3m, cv- 3m, cv+ 12m, cv- 12m, cv+ 24m 36m 36m 55m Builds a case for cv as a chronic AMR feature
10
11 Tissue Regeneration versus Fibrosis: The Process of Wound Healing Initiation Phase Ag dependent Ag independent Matrix Phase Fibrogenesis Phase Inflammatory response Proliferative response Jnl Clin Investigation 2007; 117: 524
12 Graft Survival is Lower in Patients With SCR Associated with IFTA (i+ifta) Tubulo-interstitial inflammation in early surveillance biopsies is associated with progression of IF and decreased allograft survival [Nankivell et al. Transplantation 2004; 78:242; Choi et al. AJT 2005;5: 1354]. Surveillance biopsies with i in non-scarred areas and IFTA [IFTA + i] are associated with shorter graft survival. 75% BR
13 Banff 2007 Criteria: Scoring of Total Inflammation (ti) in the Allograft Total index of interstitial inflammation which uses the same semi-quantitative criteria used for determining the i score, for all cortical tissue present, including the sub-capsular cortex, perivascular cortex and areas of IF/TA. Cortical nodular infiltrates will be included in the i or ti score depending on their localization Am J Transplant Apr;8(4): Score ti 0 ti1 ti2 ti3 Criteria No or trivial interstitial inflammation (<10% of parenchyma) 10 25% of parenchyma inflamed 26 50% of parenchyma inflamed >50% of parenchyma inflamed
14 Total i Score: Better Predictor of Outcome (and gene expression) 129 biopsies Total i= infiltrates in areas of nonscarred tubulointerstitium, in areas of interstitial fibrosis and tubular atrophy (IFTA), nodular infiltrates perivascular infiltrates, subcapsular infiltrates Mengel at al. Am Journal Transplant 2009; 9: 1859
15 IFTA + i and DSA 598 kidney transplant recipients of low immune risk (CTX neg, PRA<20%, DSA neg) Basiliximab, CNI based therapy 6w and 12m biopsies with DSA measurements (LabScreen)/ MFI<1000 = negative normal histology (i+t 1 and ci+ct 1) inflammation (i+t 2 and ci+ct 1) IFTA (i+t 1 and ci+ct 2) IFTA+i (i+t 2 and ci+ct 2) Findings of 6w are independent risk for dndsa (8.9% of pop at 1y) Factor OR of dndsa HLADR MM 1.95 ( ) i score at 6w biopsy 5.49 ( ) IFTA+i at 6w 4.09 ( ) Garcia-Carro et al. Transplantation 2016; PMID
16 Deterioration of Kidney Allograft Function (DeKAF) Study (NIH U01 AI58013) 7 transplant centers Hennepin County Med Center (Kasiske) Mayo Clinic (Cosio) University of Alabama (Gaston/Mannon) University of Alberta (Halloran/Gorishankar) University of Iowa (Hunsicker) University of Manitoba (Rush) University of Minnesota (Matas) Central pathology Central anti-hla antibody Central urine metabolomics Multicenter database and Biostatistics Core Mayo Clinic (Grande) UCLA (Cecka) University of Manitoba (Rush) University of Minnesota (Connett, Leduc, Fieberg)
17 Deterioration of Kidney Allograft Function (DeKAF) Study Prospective cohort (N=3751) Kidney or kidney-pancreas transplant with no other organs simultaneously transplanted Enrolled within 10 days post-transplant Clinical and biopsy data entered into the database Cross sectional cohort (N=440) Enrolled as of 02/01/2006 scr < 2.0 mg/dl prior to 01/01/06 Deterioration of function (>25% baseline) or new proteinuria, i.e. Biopsy for cause Pathology, urine mass spec, serum for DSA Mean Creatinine - 1/ ± 0.3 mg/dl
18 Characteristics of Cohorts Am J Transplant 2010; 10: CSC (N=422) Prospective (N=2270) Female 211 (50%) 864 (38%) Race Caucasian 333 (79%) 1740 (77%) AA 56(13%) 376 (17%) Mean age ± SD 48±18 48±14 Diabetes 169 (41%) 813 (37%) Years Post Transplant to Biopsy 7.4±6.1 (median 5.7y) 1.0±0.6 (median 0.8y) Living Donor 262 (62%) 1239 (59%) % graft Survival (post enrollment) 6m 89.5% 98% 12m 79% 96% 18m 74% 95%
19 Cross Sectional Cohort Local Biopsy Diagnoses * adds up to >100% as 2 diagnoses/biopsy Primary/Secondary DX N=425 N (%) Allograft nephropathy 196 (48) CNI toxicity 116 (29) Other (e.g., pyelo) 91 (22) Transplant glomerulopathy 82 (20) Acute cellular rejection 76 (19) Recurrent disease 53 (13) Art. nephrosclerosis 33 (8) Borderline change 28 (7) Acute antibody mediated rejection 29 (7) Glomerulonephritis (de novo) 23 (6) ATN 18 (4) Polyomavirus (BK) 11 (3) NPD 9 (2) Inadequate 4 (1)
20 Impact of CAN (IF/TA): Graft Survival in CSC After Renal Biopsy Matas et al. Am J Transplant 2010; 10:
21 DeKAF Cross Sectional Cohort: Graft Survival after Biopsy CNI Toxicity versus none CNI Toxicity No CNI Toxicity Transplantation Jul 15;90(1):68-74.
22 Depiction of Clusters Cluster Clock With additional histo scores Legend Each spoke represents a Banff score Length of spokes = % with finding Cluster 6 = Banff = Banff 2 = Banff 3 All BANFF shown Clustering based on Banff scores (i, t, g, v, ct, ci, cv, cg, mm, ah) plus tatr, iatr, ptc
23 Hierarchical Cluster Analysis of CS Biopsies Using Selected Banff Scores i, t, g, ct, ci, cv, mm, ah, and tatr Legend Length of spokes = % with finding. = Banff = Banff 2 = Banff Clusters 1 no inflamm, min ci and min mm 2 i, t 3 +4 mm, ah, cv 5 +6 inflam, and 2,3 4
24 Demographics of Clusters No major differences in: donor or recipient age race/ethnicity primary kidney disease living/deceased donor prior transplants transplant era initial immunosuppressive protocol
25 Actuarial Graft Survival Based on Clustering Am J Transplant 2010; 10:
26 Characteristics of the 6 Computer- Generated Clusters Am J Transplant 2010; 10:
27 Findings in For Cause Biopsies in Late Allograft Dysfunction IATR TATR iatr inflammation in areas of tubular atrophy 0 = inflammation in less than 10% of atrophic regions 1 = inflammation in 10-25% of atrophic regions; 2 = inflammation in 26-50% of atrophic regions; 3 = inflammation in >50% of atrophic regions. Mannon et al. Am Jnl Transplant 2010; 10: 2066
28 Impact on Presence of IATR on Graft Failure after Biopsy iatr=0 iatr 1 Months from Biopsy Mannon et al. Am Jnl Transplant 2010; 10:
29 Grade of IATR Impacts Time to Graft Loss iatr Hazard Ratio [95% Confidence Interval]; P-value 0 REF* [0.891, 5.77]; [1.07, 8.34]; [1.58, 14.27]; p= Months from Biopsy Mannon et al. Am Jnl Transplant 2010; 10:
30 IATR Has Independent Effect on Time to Death Censored Graft Failure i 1 None Iatr
31 Proportional Hazards Regression Models of Time to Death-Censored Graft Failure: IATR and Other Factors Group Model 1 Adjusted for creatinine Model 2 Adjusted for i and creatinine Model 3 Adjusted for ci and creatinine Model 4 Adjusted for ct and creatinine Model 5 Adjusted for ci and ct and creatinine Model 6 Adjusted for i, ci, ct, C4d +, DSA + and creatinine iatr=0 REF* REF REF REF REF REF iatr= [0.95,3.90]; [1.17,5.20]; [0.77,3.30]; [0.81,3.48]; [0.77,3.32]; [1.05,10.68]; iatr= [1.26,5.02]; [1.95,9.82] < [1.02,4.38]; [0.96,4.16]; [0.99,4.35]; [1.44,18.07]; iatr= [2.91,13.85]; < [4.4,32.61]; < [1.39,8.13]; [1.42,8.33]; [1.29,8.06]; [1.71,38.07]; Overall p- value for iatr < <
32 Summary Late allograft failure attributed to T cell rejection is less commonly described in the literature. Arteriosclerotic lesions may classify Banff Chronic TCMR but are in part donor derived, worsen during the post-transplant period, and accelerated in the setting of donor specific antibodies. Late cellular rejection can be seen in allograft biopsies and contributes to graft loss. In biopsies for late allograft dysfunction, inflammation in areas of atrophy is an independent risk factor for death-censored graft loss, even in the setting of antibody mediated injury features.
33 Conclusions The classification of Chronic TCMR needs updating and will need inclusion of both T and B cell activation reflecting contributions of both cellular (innate and adaptive) and humoral arms of the immune response.
34
35
36 Selection of Final Number of Clusters Selection of the final number of clusters requires specification of objective criteria and clinical input Heuristic measures are available depending on the specific clustering algorithm (pseudo-f, pseudo-r 2, cubic clustering criterion) When the true number of clusters is unknown, one heuristic is to select a number close to Sqrt(N/2)
37 2 Clustering Analyses February / 09 November / 08
38 Selected Banff i, g, ct, cv, mm, ah, and tatr used in clustering; i - mononuclear cell interstitial infiltrate g - glomerulitis hyaline ct - tubular atrophy thickening All Banff cv -( vascular plus iatr, fibrous intimal thickening of tatr, ptc) depicted: t - tubulitis v- intimal arteritis ci - interstitial fibrosis cg - glomerulopathy iatr - infl in areas of atrophy ptc peritubular capillary infiltrates mm - mesangial matrix ah - arteriolar tatr tubulitis in areas atrophy
39 Selected Banff I, g, ct, cv, mm, ah, and tatr Cluster 1 no infl; min ci; min mm 2 I,T 6 infl & severe ci,ct DeKAF clusters (n=265); 25 observations not depicted
40 Introduction Majority of recipients with slow deterioration of function are labeled as having chronic rejection, chronic allograft nephropathy (CAN), or "interstitial fibrosis with tubular atrophy (IF/TA). These diagnostic terms do not define specific entities from the etiologic, physiologic, pathologic, or prognostic point of view. The above factors make development of treatment algorithms for care of recipients with persistent and/or progressive graft dysfunction difficult, if not impossible.
41 Inflammation in Areas of Atrophy: Strong Negative Predictor of Outcome DeKAF Study: 289 recipients in cohort 59 with graft loss 89 with i=0, and iatr>1 iatr inflammation in areas of tubular atrophy 0 = inflammation in less than 10% of atrophic regions 1 = inflammation in 10-25% of atrophic regions; 2 = inflammation in 26-50% of atrophic regions; 3 = inflammation in >50% of atrophic regions. Grande et al. Banff Poster Session Matas et al. Next lecture
42
43 Relative Expression Fibrosis and Fibrogenesis Transcripts in BK PVN Biopsies SF; n=10 AR; n=14 PVN; n= SF; n=10 AR; n=14 PVN; n=10 # * # * # # # # * * # * * Normal Kidney COLIVA5 FN1 VIM FGF2 IGF1 CTGF VEGF COLIA1 PDGFb TGF-b 0.1 E-CAD S100A4 a-sma MMP2 MMP9 PAI-1 BMP7 Structural Growth Factors EMT Regulators Mannon et al. AJT 2005; 5:
44 Alloantibody and Autoantibody Associations with CGI Endothelial injury mediated by antibody, complement, monocytes, leukocytes Outcomes impacted by presence of DSA. Effective treatment options?
45 Summary/Conclusion Chronic graft injury is a considerable long term problem for solid organ transplant recipients. The etiologies are multi-factorial and include both antigen dependent and independent events, some of which are beyond clinical control. Regardless of insult, the response to inflammation is fibrosis. Primary injury may occur in the endothelium, microvasculature, or epithelium. In the kidney, epithelial injury occurs and may be associated with EMT. CNI toxicity contributes to allograft fibrosis, but is not the only factor. Identifying novel mediators and targets may provide for specific opportunities for therapy.
46 Local Pathologists Primary or Secondary Diagnosis for Each Cluster #1 (n=94) #2 (n=40) #3 (n=49) #4 (n=14) #5 (n=29) #6 (n=14) CAN (%) Transplant glomerulopathy (%) CNI toxicity (%) Acute cellular rejection (%) Ab-mediated rejection (%)
47 Characteristics at Biopsy for Each Cluster #1 (n=94) #2 (n=40) #3 (n=49) #4 (n=14) #5 (n=29) #6 (n=14) C4d positive (%) Donor specific Ab + (%) Proteinuria >60 mg/g CR (%) Time from tx to biopsy (mos) (± SD) 85 (65) 53 (52) 71 (53) 58 (32) 134 (104) 126 (78)
48 Other Analyses Cross-sectional Cohort 1) Level of C4d+ staining of peritubular capillaries correlates with long-term graft survival Optimal cutoff has not been determined; 10% strong predictor of graft loss 2) Time to graft failure is significantly associated with C4d+ status but not AR (in late post-transplant biopsies)
49 Depiction of Clusters Cluster Clock Legend Each spoke represents a Banff score Length of spokes = % with finding. = Banff = Banff 2 = Banff 3 Clustering based on 6 Banff scores (i, g, ct, cv, mm, ah) plus tatr
50 Depiction of Clusters Cluster Clock Legend Each spoke represents a Banff score Length of spokes = % with finding. = Banff = Banff 2 = Banff 3 Clustering based on 6 Banff scores (i, g, ct, cv, mm, ah) plus tatr Cluster 6
51 Cluster 1 Cluster 6
52 Histopathologic Clusters Differentiate Subgroups Within the Nonspecific Diagnoses of CAN or CR: Preliminary Data from the DeKAF Study 25 observations not depicted Am Jnl Transplant 2010; 10: 315
53 Histopathologic Clusters Differentiate Subgroups Within the Nonspecific Diagnoses of CAN or CR: Preliminary Data from the DeKAF Study Am Jnl Transplant 2010; 10:
54 C4d + Progressed More Rapidly to Graft Failure than DSA + Patients with C4d or DSA or both had worse outcomes (p<0.0001) Transplantation Jul 15;90(1):68-74.
55 Inflammation in Areas of Atrophy: Strong Negative Predictor of Outcome DeKAF Study: 289 recipients in cohort 59 with graft loss 89 with i=0, and iatr>1 iatr inflammation in areas of tubular atrophy 0 = inflammation in less than 10% of atrophic regions 1 = inflammation in 10-25% of atrophic regions; 2 = inflammation in 26-50% of atrophic regions; 3 = inflammation in >50% of atrophic regions. Mannon RB. Am Jnl Transplant 2010; 10:
56 6 month protocol bx Similar data relating inflammation with fibrosis and poor outcome: Cosio AJT 2005; 5:1464 Park WD JASN 2010;21: 1987 Moresco et al. Am Jnl Transplant 2006; 6:
57 Chronic TCMR Chronic TCMR was defined by sclerosing transplant arteriopathy. This lesion is characterized by intimal widening due to the de novo accumulation of collagens I and III, lack of elastosis, and varying degrees of intimal inflammation with mononuclear inflammatory cells. In sclerosing transplant arteriopathy, the intima usually contains varying numbers of myofibroblasts, occasional foam cells, and, in active disease stages, scattered, often clustered mononuclear inflammatory cells that may be most prominent along the inner elastic lamina. Endothelial cells are often enlarged with reactive nuclei sometimes overlying an ill-defined ring of smooth muscle cells: that is, so-called neomedia formation.
58 Cohort Local Biopsy Diagnoses * adds up to >100% as 2 diagnoses/biopsy Primary/Secondary DX CSC (N=425 ) N (%) Prospective (N=227) N (%) Acute antibody mediated rejection 29 (7) 18 (8) Acute cellular rejection 76 (19) 77 (34) ATN 18 (4) 25 (11) Allograft nephropathy 196 (48) 61 (27) Art. nephrosclerosis 33 (8) 5 (2) Borderline change 28 (7) 18 (8) CNI toxicity 116 (29) 25 (11) Glomerulonephritis (de novo) 23 (6) 7 (3) NPD 9 (2) 23 (10) Polyomavirus (BK) 11 (1) 18 (8) Recurrent disease 53 (13) 9 (4) Transplant glomerulopathy 82 (20) 16 (7) Inadequate 4 (1) 2 (1) Other (e.g., pyelo) 91 (22) 48 (21)
59 Tissue Regeneration versus Fibrosis: The Process of Wound Healing Initiation Phase Ag dependent Ag independent Matrix Phase Fibrogenesis Phase Inflammatory response Proliferative response Jnl Clin Investigation 2007; 117: 524
60 Graft Survival is Lower in Patients With SCR Associated with IFTA (i+ifta) 6 month protocol bx 75% BR Similar data relating inflammation with fibrosis and poor outcome: Cosio AJT 2005; 5:1464 Park WD JASN 2010;21: 1987 Moresco et al. Am Jnl Transplant 2006; 6:
61 Tubulointerstitial inflammation in early surveillance biopsies is associated with progression of IF and decreased allograft survival [Nankivell et al. Transplantation 2004; 78:242; Choi et al. AJT 2005;5: 1354]. Surveillance biopsies with i in non-scarred areas and IFTA [IFTA + i] are associated with shorter graft survival IFTA + i
62 IFTA + i and DSA 598 kidney transplant recipients of low immune risk (CTX neg, PRA<20%, DSA neg) Basiliximab, CNI based therapy 6w and 12m biopsies with DSA measurements (LabScreen)/ MFI<1000 = negative normal histology (i+t 1 and ci+ct 1) inflammation (i+t 2 and ci+ct 1) IFTA (i+t 1 and ci+ct 2) IFTA+i (i+t 2 and ci+ct 2) Findings of 6w are independent risk for dndsa (8.9% of pop at 1y) Factor OR of dndsa HLADR MM 1.95 ( ) i score at 6w biopsy 5.49 ( ) IFTA+i at 6w 4.09 ( ) Garcia-Carro et al. Transplantation 2016; PMID
Statement of Disclosure
Statement of Disclosure Mark Haas serves as a paid consultant on pathology adjudication committees for two industry-sponsored clinical trials: Shire ViroPharma Treatment of Acute ABMR AstraZeneca Treatment
More informationThe Banff Classification for Diagnosis of Renal Allograft Rejection: Updates from the 2017 Banff Conference
The Banff Classification for Diagnosis of Renal Allograft Rejection: Updates from the 2017 Banff Conference Mark Haas Cedars-Sinai Medical Center Los Angeles, California, USA Statement of Disclosure Mark
More informationImmunopathology of T cell mediated rejection
Immunopathology of T cell mediated rejection Ibrahim Batal MD Columbia University College of Physicians & Surgeons New York, NY, USA Overview Pathophysiology and grading of TCMR TCMR is still a significant
More informationManagement of Rejection
Management of Rejection I have no disclosures Disclosures (relevant or otherwise) Deborah B Adey, MD Professor of Medicine University of California, San Francisco Kidney and Pancreas Transplant Center
More informationBiopsy Features of Kidney Allograft Rejection Banff B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary
Biopsy Features of Kidney Allograft Rejection Banff 2017 B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary Treatment of allograft dysfunction should rely on the biopsy findings
More informationRenal Pathology- Transplantation. Eva Honsova Institute for Clinical and Experimental Medicine Prague, Czech Republic
Renal Pathology- Transplantation Eva Honsova Institute for Clinical and Experimental Medicine Prague, Czech Republic eva.honsova@ikem.cz Kidney has a limited number of tissue reactions by which the kidney
More informationJames E. Cooper, M.D. Assistant Professor, University of Colorado at Denver Division of Renal Disease and Hypertension, Kidney and PancreasTransplant
James E. Cooper, M.D. Assistant Professor, University of Colorado at Denver Division of Renal Disease and Hypertension, Kidney and PancreasTransplant Program Has no real or apparent conflicts of interest
More informationKidney Summary. Mark Haas Cedars-Sinai Medical Center Los Angeles, California, USA
Kidney Summary Mark Haas Cedars-Sinai Medical Center Los Angeles, California, USA Key Issues to Address re: the Classification 1. Incorporation of i-ifta + tubulitis into the TCMR classification - Defining
More informationPathological back-ground of renal transplant pathology and important mile-stones of the Banff classification
Banff 1 Banff Pathological back-ground of renal transplant pathology and important mile-stones of the Banff classification Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital Morozumi Kunio,
More informationRecognition and Treatment of Chronic Allograft Dysfunction
Recognition and Treatment of Chronic Allograft Dysfunction Alexander Wiseman, M.D. Associate Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney and Pancreas Transplant Programs
More informationSCORING OF i-ifta: POTENTIAL RULES & ROLE IN CHRONIC TCMR
SCORING OF i-ifta: POTENTIAL RULES & ROLE IN CHRONIC TCMR Parmjeet Randhawa, MD Professor of Pathology The Thomas E Starzl Transplantation Institute University of Pittsburgh . I HAVE NO CONFLICTS OR FINANCIAL
More informationDSA Positive and then To biopsy or not?
DSA Positive and then To biopsy or not? Banff SCT 2017 29 March 2017 Peter Nickerson, MD, FRCPC, FCAHS Flynn Family Chair in Renal Transplantation Professor of Internal Medicine and Immunology Relevant
More informationInterstitial Inflammation
Interstitial Inflammation Currently considered to be T cell-mediated process Plasma cell rich acute rejection often associated with AMR Preliminary data suggests that interstitial follicular helper T cells
More informationPathology of Kidney Allograft Dysfunction. B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary
Pathology of Kidney Allograft Dysfunction B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary The gold standard for exploration of the cause of an allograft dysfunction is to perform
More informationReview of Rituximab and renal transplantation. Dr.E Nemati. Professor of Nephrology
Review of Rituximab and renal transplantation Dr.E Nemati Professor of Nephrology Introductio n Rituximab is a chimeric anti-cd20 monoclonal antibody. The CD20 antigen is a transmembrane nonglycosylated
More informationInterpretation of Renal Transplant Biopsy. Arthur H. Cohen Wake Forest University School of Medicine Winston-Salem, North Carolina USA
Interpretation of Renal Transplant Biopsy Arthur H. Cohen Wake Forest University School of Medicine Winston-Salem, North Carolina USA Renal Transplant Biopsies Tissue Processing Ideal world process as
More informationHLA and Non-HLA Antibodies in Transplantation and their Management
HLA and Non-HLA Antibodies in Transplantation and their Management Luca Dello Strologo October 29 th, 2016 Hystory I 1960 donor specific antibodies (DSA): first suggestion for a possible role in deteriorating
More informationPathology of Kidney Allograft Dysfunction. B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary
Pathology of Kidney Allograft Dysfunction B. Ivanyi, MD Department of Pathology, University of Szeged, Szeged, Hungary The renal biopsy is a powerful tool in the diagnostic evaluation of allograft dysfunction
More informationRisk Factors in Long Term Immunosuppressive Use and Advagraf. Daniel Serón Nephrology department Hospital Universitari Vall d Hebron
Risk Factors in Long Term Immunosuppressive Use and Advagraf Daniel Serón Nephrology department Hospital Universitari Vall d Hebron Progressive well defined diseases ABMR GN Polyoma Non-specific Findings
More informationHistopathology: Hypertension and diabetes in the kidney These presentations are to help you identify basic histopathological features.
Histopathology: Hypertension and diabetes in the kidney These presentations are to help you identify basic histopathological features. They do not contain the additional factual information that you need
More informationSpecial thanks to our clinical collaborators Special thanks to our patients. Administration. Andre Baretto
Antibody-mediated rejection: a prototype for antibody-mediated diseases Phil Halloran Alberta Transplant Applied Genomics Centre Edmonton, Canada Disclosures PFH has shares in TSI a university spinoff
More informationHistopathological evaluation of renal allograft biopsies in Nepal: interpretation and significance
Nepal Medical Association Building Exhibition Road, Kathmandu Journal of Pathology of Nepal (2012) Vol. 2, 172-179 Association of Clinical Pathologist of Nepal-2010 Journal of PATHOLOGY of Nepal www.acpnepal.com
More informationEvolution of the approaches toward grading and classifying chronic changes in the renal allograft: Banff classification updates III
EDITORIAL Advance Access publication 24 February 2014 Evolution of the approaches toward grading and classifying chronic changes in the renal allograft: Banff classification updates III Histopathology
More informationWhy Do We Need New Immunosuppressive Agents
Why Do We Need New Immunosuppressive Agents 1 Reducing acute rejection rates has not transplanted into better long-term graft survival Incidence of early acute rejection episodes by era Relative risk for
More informationHistopathological findings in transplanted kidneys
Katsuma et al. Renal Replacement Therapy (2017) 3:6 DOI 10.1186/s41100-016-0089-0 REVIEW Histopathological findings in transplanted kidneys Ai Katsuma, Takafumi Yamakawa, Yasuyuki Nakada, Izumi Yamamoto
More informationUpdate on Transplant Glomerulopathy
Update on Transplant Glomerulopathy Miklos Z Molnar, MD, PhD, FEBTM, FERA, FASN Associate Professor of Medicine Division of Nephrology, Department of Medicine University of Tennessee Health Science Center
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Lefaucheur C, Loupy A, Vernerey D, et al. Antibody-mediated
More informationDiagnosis and Management of Acute and Chronic Humoral Rejection. Lars Pape
Diagnosis and Management of Acute and Chronic Humoral Rejection Lars Pape Immunosuppression Acute rejection Chronic rejection Side effects Infections Nephrotoxicity Adult population Nearly all late rejection-related
More informationThe Histology of Kidney Transplant Failure: A Long-Term Follow-Up Study
CLINICAL AND TRANSLATIONAL RESEARCH The Histology of Kidney Transplant Failure: A Long-Term Follow-Up Study Maarten Naesens, 1,2,6 Dirk R.J. Kuypers, 1,2 Katrien De Vusser, 1,2 Pieter Evenepoel, 1,2 Kathleen
More informationRENAL EVENING SPECIALTY CONFERENCE
RENAL EVENING SPECIALTY CONFERENCE Harsharan K. Singh, MD The University of North Carolina at Chapel Hill Disclosure of Relevant Financial Relationships No conflicts of interest to disclose. CLINICAL HISTORY
More informationAcute renal failure (ARF) in the transplanted kidney represents a
Acute Renal Failure in the Transplanted Kidney Kim Solez Lorraine C. Racusen Acute renal failure (ARF) in the transplanted kidney represents a high-stakes area of nephrology and of transplantation practice.
More informationThe Banff Conferences on renal allograft pathology the latest 2013 report
615245PSH0010.1177/2010105815615245Proceedings of Singapore HealthcareLoh research-article2015 Review Article PROCEEDINGS OF SINGAPORE HEALTHCARE The Banff Conferences on renal allograft pathology the
More informationThe new Banff vision of the role of HLA antibodies in organ transplantation: Improving diagnostic system and design of clinical trials
The new Banff vision of the role of HLA antibodies in organ transplantation: Improving diagnostic system and design of clinical trials Carmen Lefaucheur 1 2 Banff 2015: Integration of HLA-Ab for improving
More informationOrdering Physician. Collected REVISED REPORT. Performed. IgG IF, Renal MCR. Lambda IF, Renal MCR. C1q IF, Renal. MCR Albumin IF, Renal MCR
RenalPath Level IV Wet Ts IgA I Renal IgM I Renal Kappa I Renal Renal Bx Electron Microscopy IgG I Renal Lambda I Renal C1q I Renal C3 I Renal Albumin I Renal ibrinogen I Renal Mayo Clinic Dept. of Lab
More informationThe Banff 2015 Kidney Meeting Report: Current Challenges in Rejection Classification and Prospects for Adopting Molecular Pathology
The Banff 2015 Kidney Meeting Report: Current Challenges in Rejection Classification and Prospects for Adopting Molecular Pathology The Harvard community has made this article openly available. Please
More informationThe transcriptome of the renal transplant biopsy: the lessons. Philip F Halloran
The transcriptome of the renal transplant biopsy: the lessons Philip F Halloran Alberta Transplant Applied Genomics Centre April 27 th 2009 Congratulations on your 50 th anniversary ATAGC Learning objectives:
More informationLiterature Review Transplantation
Literature Review 2010- Transplantation Alexander Wiseman, M.D. Associate Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney and Pancreas Transplant Programs University of
More informationThe causes, significance and consequences of inflammatory fibrosis in kidney transplantation: The Banff i- IFTA lesion
Received: 31 May 2017 Revised: 25 October 2017 Accepted: 28 October 2017 DOI: 10.1111/ajt.14609 ORIGINAL ARTICLE The causes, significance and consequences of inflammatory fibrosis in kidney transplantation:
More informationDonor-derived Cell-free DNA Improves DSA-informed Diagnosis of ABMR in Kidney Transplant Patients
Donor-derived Cell-free DNA Improves DSA-informed Diagnosis of ABMR in Kidney Transplant Patients Stanley C. Jordan, MD Director, Division of Nephrology Medical Director, Kidney Transplant Program Medical
More informationImpact of Subclinical Rejection on Transplantation
Trends in Transplantation 2007;1:56-60 Impact of Subclinical Rejection on Transplantation David N. Rush for the Winnipeg Transplant Group Transplant Manitoba Adult Kidney Program, University of Manitoba,
More informationAs outlined under External contributions (see appendix 7.1), the group of Prof. Gröne at the
3 RESULTS As outlined under External contributions (see appendix 7.1), the group of Prof. Gröne at the DKFZ in Heidelberg (Dept. of Cellular and Molecular pathology) contributed to this work by performing
More informationDr Ian Roberts Oxford. Oxford Pathology Course 2010 for FRCPath Illustration-Cellular Pathology. Oxford Radcliffe NHS Trust
Dr Ian Roberts Oxford Oxford Pathology Course 2010 for FRCPath Plan of attack: Diagnostic approach to the renal biopsy Differential diagnosis of the clinical syndromes of renal disease Microscopy Step
More informationPost-Transplant Monitoring for the Development of Anti-Donor HLA Antibodies
Post-Transplant Monitoring for the Development of Anti-Donor HLA Antibodies Lorita M Rebellato, Ph.D., D (ABHI) Associate Professor Department of Pathology The Brody School of Medicine at ECU Scientific
More informationClassification of Glomerular Diseases and Defining Individual Glomerular Lesions: Developing International Consensus
Classification of Glomerular Diseases and Defining Individual Glomerular Lesions: Developing International Consensus Mark Haas MD, PhD Department of Pathology & Laboratory Medicine Cedars-Sinai Medical
More informationUpdate on Transplant Glomerulopathy
Update on Transplant Glomerulopathy Miklos Z Molnar, MD, PhD, FEBTM, FERA, FASN Associate Professor of Medicine Methodist University Hospital, Transplant Institute Division of Transplantation, Department
More informationPrimer: histopathology of calcineurin-inhibitor toxicity in renal allografts
Primer: histopathology of calcineurin-inhibitor toxicity in renal allografts Peter Liptak and Bela Ivanyi* SUMMARY Calcineurin inhibitors (ciclosporin and tacrolimus) can cause acute and chronic nephrotoxicity.
More informationNo evidence of C4d association with AMR However, C3d and AMR correlated well
C4d positivity Poor prognostic factor Reversal to C4d negativity did not change prognosis, with current therapy Prognostic factor for CAV Variable time line for CAV/death No correlation with cellular rejection
More informationCase Presentation Turki Al-Hussain, MD
Case Presentation Turki Al-Hussain, MD Director, Renal Pathology Chapter Saudi Society of Nephrology & Transplantation Consultant Nephropathologist & Urological Pathologist Department of Pathology & Laboratory
More informationBanff Vascularized Composite Allotransplantation
Banff Vascularized Composite Allotransplantation Linda C. Cendales, M.D. Associate Professor of Surgery Duke Health Scholar Director, Vascularized Composite Allotransplantation Duke University Medical
More informationLong-term prognosis of BK virus-associated nephropathy in kidney transplant recipients
Original Article Kidney Res Clin Pract 37:167-173, 2018(2) pissn: 2211-9132 eissn: 2211-9140 https://doi.org/10.23876/j.krcp.2018.37.2.167 KIDNEY RESEARCH AND CLINICAL PRACTICE Long-term prognosis of BK
More informationHistopathology: Vascular pathology
Histopathology: Vascular pathology These presentations are to help you identify basic histopathological features. They do not contain the additional factual information that you need to learn about these
More informationAntibody Mediated Rejection (AMR) in LUNG TRANSPLANT Recipients
Antibody Mediated Rejection (AMR) in LUNG TRANSPLANT Recipients Lorriana Leard, MD UCSF Transplant Pulmonologist Associate Professor of Clinical Medicine Vice Chief of Clinical Activities Pulmonary, Critical
More informationHLA Part II: My Patient Has DSA, Now What?
2017 CST-Astellas Canadian Transplant Fellows Symposium HLA Part II: My Patient Has DSA, Now What? James Lan, MD, FRCPC, D(ABHI) Dr. Lan completed his nephrology training at the University of British Columbia.
More informationProgressive histological damage in renal allografts is associated with expression of innate and adaptive immunity genes
http://www.kidney-international.org & 2011 International Society of Nephrology see commentary on page 1254 Progressive histological damage in renal allografts is associated with expression of innate and
More informationMonoclonal Gammopathies and the Kidney. Tibor Nádasdy, MD The Ohio State University, Columbus, OH
Monoclonal Gammopathies and the Kidney Tibor Nádasdy, MD The Ohio State University, Columbus, OH Monoclonal gammopathy of renal significance (MGRS) Biopsies at OSU (n=475) between 2007 and 2016 AL or AH
More informationThe organs of the human body were created to perform ten functions among which is the function of the kidney to furnish the human being with thought.
The organs of the human body were created to perform ten functions among which is the function of the kidney to furnish the human being with thought. Leviticus Rabba 3 Talmud Berochoth 6 1 b Outline &
More informationDr Ian Roberts Oxford
Dr Ian Roberts Oxford Oxford Pathology Course 2010 for FRCPath Present the basic diagnostic features of the commonest conditions causing renal failure Highlight diagnostic pitfalls. Crescentic GN: renal
More informationLe Rejet Humoral Chronique en 2010: Histoire naturelle et problématiques
Le Rejet Humoral Chronique en 2010: Histoire naturelle et problématiques CAMR in 2010: natural history and perspectives Alexandre Loupy 1 Introduction 2 CAMR: the missing link 3 Natural history of CAMR
More informationInduction of donor-specific hyporesponsiveness after renal. transplantation. Long term follow-up
Induction of donor-specific hyporesponsiveness after renal transplantation. Long term follow-up Marc Lúcia, Oriol Bestard, Marcel la Franquesa, Josep M Cruzado, Montse Gomà, Núria Bolaños, Gema Cerezo,
More informationThe Histology of Solitary Renal Allografts at 1 and 5 Years After Transplantation
American Journal of Transplantation 2011; 11: 698 707 Wiley Periodicals Inc. C 2010 CSIRO C 2010 The Authors Journal compilation C 2010 The American Society of Transplantation and the American Society
More informationAntibody-Mediated Rejection in the Lung Allograft. Gerald J Berry, MD Dept of Pathology Stanford University Stanford, CA 94305
Antibody-Mediated Rejection in the Lung Allograft Gerald J Berry, MD Dept of Pathology Stanford University Stanford, CA 94305 Gerald J Berry, MD Professor of Pathology Stanford University, Stanford, CA
More informationDE-MYSTIFYING THE BLACK BOX OF TRANSPLANT IMMUNOLOGY
2016 DE-MYSTIFYING THE BLACK BOX OF TRANSPLANT IMMUNOLOGY James H Lan, MD, FRCP(C), D(ABHI) Clinical Assistant Professor, University of British Columbia Nephrology & Kidney Transplantation, Vancouver General
More informationSurgical Pathology Report
Louisiana State University Health Sciences Center Department of Pathology Shreveport, Louisiana Accession #: Collected: Received: Reported: 6/1/2012 09:18 6/2/2012 09:02 6/2/2012 Patient Name: Med. Rec.
More informationThe diffuse extent of peritubular capillaritis in renal allograft rejection is an independent risk factor for graft loss
http://www.kidney-international.org 2015 International Society of Nephrology see commentary on page 218 The diffuse extent of peritubular capillaritis in renal allograft rejection is an independent risk
More informationBK virus infection in renal transplant recipients: single centre experience. Dr Wong Lok Yan Ivy
BK virus infection in renal transplant recipients: single centre experience Dr Wong Lok Yan Ivy Background BK virus nephropathy (BKVN) has emerged as an important cause of renal graft dysfunction in recent
More informationA clinical syndrome, composed mainly of:
Nephritic syndrome We will discuss: 1)Nephritic syndrome: -Acute postinfectious (poststreptococcal) GN -IgA nephropathy -Hereditary nephritis 2)Rapidly progressive GN (RPGN) A clinical syndrome, composed
More information2017 BANFF-SCT Joint Scientific Meeting. BARCELONA March 2017
2017 BANFF-SCT Joint Scientific Meeting BARCELONA 27-31 March 2017 Adriana Zeevi PhD (D) ABHI Professor of Pathology, Surgery and Immunology Director of Histocompatibility Laboratory University of Pittsburgh
More informationSELECTED ABSTRACTS. All (n) % 3-year GS 88% 82% 86% 85% 88% 80% % 3-year DC-GS 95% 87% 94% 89% 96% 80%
SELECTED ABSTRACTS The following are summaries of selected posters presented at the American Transplant Congress on May 5 9, 2007, in San Humar A, Gillingham KJ, Payne WD, et al. Review of >1000 kidney
More informationKidney Allograft Fibrosis and Atrophy Early After Living Donor Transplantation
American Journal of Transplantation 2005; 5: 1130 1136 Blackwell Munksgaard Copyright C Blackwell Munksgaard 2005 doi: 10.1111/j.1600-6143.2005.00811.x Kidney Allograft Fibrosis and Atrophy Early After
More informationHistopathology: Glomerulonephritis and other renal pathology
Histopathology: Glomerulonephritis and other renal pathology These presentations are to help you identify basic histopathological features. They do not contain the additional factual information that you
More informationLiterature Review: Transplantation July 2010-June 2011
Literature Review: Transplantation July 2010-June 2011 James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Kidney Transplant Top 10 List: July Kidney
More informationMOLECULAR PREDICTORS OF OUTCOME Ondrej Viklicky, Prague, Czech Republic. Chair: Daniel Abramowicz, Brussels, Belgium Rosanna Coppo, Turin, Italy
MOLECULAR PREDICTORS OF OUTCOME Ondrej Viklicky, Prague, Czech Republic Chair: Daniel Abramowicz, Brussels, Belgium Rosanna Coppo, Turin, Italy Prof Ondrej Viklicky Department of Nephrology Transplant
More informationDeján Dobi, MD. PhD Thesis
Clinicopathologic Relevance of Vascular Changes Associated with Transplant Glomerulopathy Secondary to Chronic Antibody-mediated Rejection in the Renal Allograft Deján Dobi, MD PhD Thesis Szeged, 2018
More informationPeritubular capillaries C4d deposits in renal allograft biopsies and anti HLA I/II alloantibodies screening Incidence and clinical importance
ORIGINAL ARTICLE Port J Nephrol Hypert 2008; 22(1): 37-42 Peritubular capillaries C4d deposits in renal allograft biopsies and anti HLA I/II alloantibodies screening Incidence and clinical importance Helena
More informationHistological picture of antibody-mediated rejection without donor-specific anti-hla
DR ALEKSANDAR SENEV (Orcid ID : 0000-0002-6196-4669) MR. MAARTEN COEMANS (Orcid ID : 0000-0001-8442-3673) Article type : Original Article Histological picture of antibody-mediated rejection without donor-specific
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 4,000 116,000 120M Open access books available International authors and editors Downloads Our
More informationChronic Calcineurin Inhibitor Nephrotoxicity: Myth or Reality?
Chronic Calcineurin Inhibitor Nephrotoxicity: Myth or Reality? Aji Djamali, MD Associate Professor of Medicine and Surgery Division Chief Nephrology University of Wisconsin School of Medicine and Public
More informationBanff-SCT 2017 Towards Uniformity of Terminology for the Pathology of CAV. Gerald J. Berry, MD Dept. of Pathology Stanford University Stanford, CA
Banff-SCT 2017 Towards Uniformity of Terminology for the Pathology of CAV Gerald J. Berry, MD Dept. of Pathology Stanford University Stanford, CA Objectives Review current terminology Identify key histopathologic
More informationSince the first Banff meeting in 1991, the diagnosis and
CLINICAL AND TRANSLATIONAL RESEARCH Acute Cellular Rejection: Impact of Donor-Specific Antibodies and C4d Michelle Willicombe, 1,5 Candice Roufosse, 2 Paul Brookes, 3 Adam G. McLean 1, Jack Galliford,
More informationCKD in Other Organ Transplants
CKD in Other Organ Transplants Alexander Wiseman, M.D. Associate Professor, Division of Renal Diseases and Hypertension Medical Director, Kidney and Pancreas Transplant Programs University of Colorado
More informationMicrocirculation Inflammation Associates With Outcome in Renal Transplant Patients With De Novo Donor-Specific Antibodies
American Journal of Transplantation 2013; 13: 485 492 Wiley Periodicals Inc. Brief Communication C Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons
More informationRENAL HISTOPATHOLOGY
RENAL HISTOPATHOLOGY Peter McCue, M.D. Department of Pathology, Anatomy & Cell Biology Sidney Kimmel Medical College There are no conflicts of interest. 1 Goals and Objectives! Goals Provide introduction
More informationBanff 09 Meeting Report: Antibody Mediated Graft Deterioration and Implementation of Banff Working Groups
American Journal of Transplantation 2010; 10: 464 471 Wiley Periodicals Inc. Meeting Report C 2010 The Authors Journal compilation C 2010 The American Society of Transplantation and the American Society
More informationDesensitization in Kidney Transplant. James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver
Desensitization in Kidney Transplant James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Organ Shortage Currently there are >90,000 patients on the kidney
More informationSteroid Minimization: Great Idea or Silly Move?
Steroid Minimization: Great Idea or Silly Move? Disclosures I have financial relationship(s) within the last 12 months relevant to my presentation with: Astellas Grants ** Bristol Myers Squibb Grants,
More informationBanff 2003 Meeting Report: New Diagnostic Insights and Standards
American Journal of Transplantation 2004; 4: 1562 1566 Blackwell Munksgaard Meeting Report Copyright C Blackwell Munksgaard 2004 doi: 10.1111/j.1600-6143.2004.00585.x Banff 2003 Meeting Report: New Diagnostic
More informationCase # 2 3/27/2017. Disclosure of Relevant Financial Relationships. Clinical history. Clinical history. Laboratory findings
Case # 2 Christopher Larsen, MD Arkana Laboratories Disclosure of Relevant Financial Relationships USCAP requires that all planners (Education Committee) in a position to influence or control the content
More informationVascular Remodelling in Pancreas Transplantation
Vascular Remodelling in Pancreas Transplantation Prof Steve White Consultant HPB/Transplant Surgeon The Freeman Hospital Newcastle President Elect EPITA European Pancreas Transplants Pancreas Transplants
More informationKidney Transplant. November 4 th, 2016
Kidney Transplant November 4 th, 2016 Brad West, MD, FACP Medical Director of Transplant Services, Memorial Medical Center Chairman Department of Nephrology, Springfield Clinic 1 Adjusted survival: 1993-1997
More informationMedicine OBSERVATIONAL STUDY
Medicine OBSERVATIONAL STUDY Clinical Significance of HLA-DQ Antibodies in the Development of Chronic Antibody-Mediated Rejection and Allograft Failure in Kidney Transplant Recipients Hyeyoung Lee, MD,
More informationUtility of protocol kidney biopsies for de novo donor- specific antibodies
Received: 6 June 2017 Revised: 24 July 2017 Accepted: 29 July 2017 DOI: 10.1111/ajt.14466 BRIEF COMMUNICATION Utility of protocol kidney biopsies for de novo donor- specific antibodies Sandesh Parajuli
More informationFuture Webinars. Handouts 18/09/ Program-Handouts.aspx
Transplant Webinar Series: Ep. 9 Bio for Post-Transplant Immune Injury Future Webinars Link to register: https://immucor.webinato.com/register All Content 215 Immucor, Inc. Handouts http://www.immucor.com/en-us/pages/educational-
More informationRecurrent Idiopathic Membranous Glomerulonephritis After Kidney Transplantation and Successful Treatment With Rituximab
TRANSPLANTATION Recurrent Idiopathic Membranous Glomerulonephritis After Kidney Transplantation and Successful Treatment With Rituximab Khadijeh Makhdoomi, 1,2 Saeed Abkhiz, 1,2 Farahnaz Noroozinia, 1,3
More informationPosttransplant Human Leukocyte Antigen Antibodies in Stable Kidney Transplant Recipients
Trends in Transplant. 2014;8:3-9 Gregor Bartel, Georg A. Böhmig: Alloantibodies and Graft Function Posttransplant Human Leukocyte Antigen Antibodies in Stable Kidney Transplant Recipients Gregor Bartel
More informationTransplant Webinar Series: Ep. 9 Biomarkers for Post-Transplant Immune Injury
Transplant Webinar Series: Ep. 9 Biomarkers for Post-Transplant Immune Injury Future Webinars Link to register: https://immucor.webinato.com/register All Content 2015 Immucor, Inc. Handouts http://www.immucor.com/en-us/pages/educational-
More informationRECURRENT AND DE NOVO RENAL DISEASES IN THE ALLOGRAFT. J. H. Helderman,MD,FACP,FAST
RECURRENT AND DE NOVO RENAL DISEASES IN THE ALLOGRAFT J. H. Helderman,MD,FACP,FAST Vanderbilt University Medical Center Professor of Medicine, Pathology and Immunology Medical Director, Vanderbilt Transplant
More informationAMR in Liver Transplantation: Incidence
AMR in Liver Transplantation: Incidence Primary AMR 1/3 to 1/2 of ABO-incompatible transplants Uncommon with ABO-compatible transplant Secondary AMR Unknown incidence: rarely tested Why is AMR uncommon
More informationA clear path forward COMING SOON THE LATEST INNOVATION IN KIDNEY TRANSPLANT SURVEILLANCE CAN DRIVE BETTER OUTCOMES FOR YOUR PATIENTS
COMING SOON A clear path forward THE LATEST INNOVATION IN KIDNEY TRANSPLANT SURVEILLANCE CAN DRIVE BETTER OUTCOMES FOR YOUR PATIENTS AlloSure is the first and only non-invasive test which assesses organ
More informationCase Report Beneficial Effect of Conversion to Belatacept in Kidney-Transplant Patients with a Low Glomerular-Filtration Rate
Case Reports in Transplantation, Article ID 190516, 4 pages http://dx.doi.org/10.1155/2014/190516 Case Report Beneficial Effect of Conversion to Belatacept in Kidney-Transplant Patients with a Low Glomerular-Filtration
More informationACCME/Disclosure. Case #1. Case History. Dr. Bracamonte has nothing to disclose
Case #1 ACCME/Disclosure Dr. Erika Bracamonte Associate Professor of Pathology University of Arizona, College of Medicine Banner University Medical Center, Tucson Dr. Bracamonte has nothing to disclose
More information